Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11164 | TN |
N | 1041S0200X | School Social Worker | 000703712 | TN |
NPI | 1003332701 |
---|---|
Provider Name | Sparka J. Perry |
First Address | Chattanooga, TN 37421-1894 |
Second Address | Chattanooga, TN 37421-1894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 15/08/2017 |